Cataract Surgery Under General Anaesthesia: Does Being In Care Delay Treatment?

Cataract surgery is a common procedure performed worldwide, commonly under topical or local anaesthesia. Often, general anaesthesia (GA) is required which can increase the risk of surgery to the patient, increase the time of the procedure and increase costs to the healthcare system. We evaluated the patient demographics and clinical indications for use of GA in cataract surgery. Furthermore, we analysed visual acuity and cataract density to understand if certain patient demographics can impact the severity of presentation at the time of referral to the cataract service. Together, these results can inform clinical decision-making regarding the selection of anaesthetic type and help to optimise management in certain patient profiles.

This study was performed across 3 sites of a large hospital with a tertiary ophthalmology centre.

There is little pre-existing literature on analysis of cataract surgery performed under general anaesthesia. A retrospective cohort analysis of 71 patients who underwent cataract surgery under GA between February 2024 and February 2025 across 3 hospital sites was performed. Exclusion criteria included cataract surgeries performed under local anaesthesia, patients < 18 years of age and surgeries for secondary cataracts or surgeries involving combined cataract surgery with additional procedures e.g. ‘phaco DMEK’.  Statistical and descriptive analysis was performed to evalute the patient demographics and cataract characteristics and to identifiy health inequality and socio-economic disparities in treatment between demographics. 

The mean age was 70 years. 27 patients were dependent on care , 49 patients were independent. The average Rockwood Frailty Score was 3.8, with the dependent group scoring 4.56 and the independent group 3.2.

Exploring the reasons for GA; in 9 patients due to dementia, 17 for anxiety, 8 for uncontrolled movements, 6 due to co-morbidities, 12 by patient request, 5 due to learning disabilities, 7 for other unspecified reasons. Most common VA at referral was 6/9.  However, this was very different between the groups with the average being 6/60 [dependent] and 6/9 [independent]. Cataract density in the dependent group was 46% grade 2+, 46% 3+, 8% brunescent cataracts vs 14% with grade 1+, 78% with 2+ and only 8% 3+ or worse in the independent .

A greater proportion of patients underwent GA due to anxiety of being awake for the procedure or due to personal preference than those who underwent GA for medical

reasons. Patients under care present to the cataract service with worse visual acuity, more dense cataracts and greater frailty than those who are not under care. There was a significant difference in cataract density at referral between groups.

Guidelines from the Royal College of Ophthalmologists (U.K.) show the need for a “sooner rather than later” approach to maximise the cognitive benefits of sight restoration in patients of dementia however these results suggest we are a long way meeting this criterion. There is similar guidance for those patients with learning disabilities.